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1.
Heliyon ; 10(10): e31562, 2024 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-38826746

RESUMEN

Background: The respiratory tract harbors a variety of microbiota, whose composition and abundance depend on specific site factors, interaction with external factors, and disease. The aim of this study was to investigate the relationship between COVID-19 severity and the nasopharyngeal microbiome. Methods: We conducted a prospective cohort study in Mexico City, collecting nasopharyngeal swabs from 30 COVID-19 patients and 14 healthy volunteers. Microbiome profiling was performed using 16S rRNA gene analysis. Taxonomic assignment, classification, diversity analysis, core microbiome analysis, and statistical analysis were conducted using R packages. Results: The microbiome data analysis revealed taxonomic shifts within the nasopharyngeal microbiome in severe COVID-19. Particularly, we observed a significant reduction in the relative abundance of Lawsonella and Cutibacterium genera in critically ill COVID-19 patients (p < 0.001). In contrast, these patients exhibited a marked enrichment of Streptococcus, Actinomyces, Peptostreptococcus, Atopobium, Granulicatella, Mogibacterium, Veillonella, Prevotella_7, Rothia, Gemella, Alloprevotella, and Solobacterium genera (p < 0.01). Analysis of the core microbiome across all samples consistently identified the presence of Staphylococcus, Corynebacterium, and Streptococcus. Conclusions: Our study suggests that the disruption of physicochemical conditions and barriers resulting from inflammatory processes and the intubation procedure in critically ill COVID-19 patients may facilitate the colonization and invasion of the nasopharynx by oral microorganisms.

3.
Artículo en Inglés | MEDLINE | ID: mdl-37580222

RESUMEN

OBJECTIVE: To describe changes in pulmonary mechanics when changing from supine position (SP) to prone position (PP) in mechanically ventilated (MV) patients with Acute Respiratory Distress Syndrome (ARDS) due to severe COVID-19. DESIGN: Retrospective cohort. SETTING: Intensive Care Unit of the National Institute of Respiratory Diseases (Mexico City). PATIENTS: COVID-19 patients on MV due to ARDS, with criteria for PP. INTERVENTION: Measurement of pulmonary mechanics in patients on SP to PP, using esophageal manometry. MAIN VARIABLES OF INTEREST: Changes in lung and thoracic wall mechanics in SP and PP RESULTS: Nineteen patients were included. Changes during first prone positioning were reported. Reductions in lung stress (10.6 vs 7.7, p=0.02), lung strain (0.74 vs 0.57, p=0.02), lung elastance (p=0.01), chest wall elastance (p=0.003) and relation of respiratory system elastances (p=0.001) were observed between patients when changing from SP to PP. No differences were observed in driving pressure (p=0.19) and transpulmonary pressure during inspiration (p=0.70). CONCLUSIONS: Changes in pulmonary mechanics were observed when patients were comparing values of supine position with measurements obtained 24h after prone positioning. Esophageal pressure monitoring may facilitate ventilator management despite patient positioning.

4.
J Interferon Cytokine Res ; 42(8): 430-443, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35708622

RESUMEN

Interferon-induced transmembrane (IFITM) proteins mediate protection against enveloped viruses by blocking membrane fusion at endosomes. IFITM1 and IFITM3 are crucial for protection against influenza, and various single nucleotide polymorphisms altering their function have been linked to disease susceptibility. However, bulk IFITM1 and IFITM3 mRNA expression dynamics and their correlation with clinical outcomes have not been extensively addressed in patients with respiratory infections. In this study, we evaluated the expression of IFITM1 and IFITM3 in peripheral leukocytes from healthy controls and individuals with severe pandemic influenza A(H1N1) or coronavirus disease 2019 (COVID-19). Comparisons between participants grouped according to their clinical characteristics, underlying disease, and outcomes showed that the downregulation of IFITM1 was a distinctive characteristic of severe pandemic influenza A(H1N1) that correlated with outcomes, including mortality. Conversely, increased IFITM3 expression was a common feature of severe pandemic influenza A(H1N1) and COVID-19. Using a high-dose murine model of infection, we confirmed not only the downregulation of IFITM1 but also of IFITM3 in the lungs of mice with severe influenza, as opposed to humans. Analyses in the comparative cohort also indicate the possible participation of IFITM3 in COVID-19. Our results add to the evidence supporting a protective function of IFITM proteins against viral respiratory infections in humans.


Asunto(s)
Antígenos de Diferenciación , COVID-19 , Gripe Humana , Proteínas de la Membrana , Proteínas de Unión al ARN , Animales , Antígenos de Diferenciación/genética , Antígenos de Diferenciación/metabolismo , COVID-19/genética , Humanos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/genética , Leucocitos/metabolismo , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismo , Ratones , Proteínas de Unión al ARN/genética , Proteínas de Unión al ARN/metabolismo
5.
Salud Publica Mex ; 64(2): 131-136, 2022 Apr 08.
Artículo en Español | MEDLINE | ID: mdl-35438919

RESUMEN

OBJETIVO: Evaluar la efectividad de las vacunas contra SARS-CoV-2 para evitar muerte e intubación en pacientes hospitalizados con Covid-19. Material y métodos. Se presentó un análisis de 3 565 hospitalizaciones por SARS-CoV-2 de personas mayores de 20 años de edad, reportadas con fines de salud pública por 10 hospitales de especialidad. Se comparó a los egresados por mejoría (2 094) con los fallecidos (1 471) en modelos mixtos de regresión logística ajustados por edad, sexo, número de comorbilidades y el hospital como variable aleatoria. RESULTADOS: Un esquema completo de vacunación, con cinco tipos de vacunas disponi-bles, tuvo un efecto protector para muerte o intubación (RM: 0.67, IC95%: 0.54,0.83, 33% de protección); y para muerte (RM: 0.80, IC95%: 0.64,0.99, 20% de protección) estos datos se compararon con los que no habían sido vacunados. Todas las vacunas aplicadas mostraron un efecto protector con un RM<0.8, con intervalos de confianza variables. Conclusio-nes. El antecedente de vacunación reduce los riesgos de ser intubado y morir, aun en pacientes previamente vacunados y hospitalizados con Covid-19 grave.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , COVID-19/epidemiología , Hospitales , Humanos , Estudios Retrospectivos , SARS-CoV-2
6.
Salud pública Méx ; 64(2): 131-136, Mar.-Apr. 2022. tab
Artículo en Español | LILACS-Express | LILACS | ID: biblio-1432363

RESUMEN

Resumen: Objetivo: Evaluar la efectividad de las vacunas contra SARS-CoV-2 para evitar muerte e intubación en pacientes hospitalizados con Covid-19. Material y métodos: Se presentó un análisis de 3 565 hospitalizaciones por SARS-CoV-2 de personas mayores de 20 años de edad, reportadas con fines de salud pública por 10 hospitales de especialidad. Se comparó a los egresados por mejoría (2 094) con los fallecidos (1 471) en modelos mixtos de regresión logística ajustados por edad, sexo, número de comorbilidades y el hospital como variable aleatoria. Resultados: Un esquema completo de vacunación, con cinco tipos de vacunas disponibles, tuvo un efecto protector para muerte o intubación (RM: 0.67, IC95%: 0.54,0.83, 33% de protección); y para muerte (RM: 0.80, IC95%: 0.64,0.99, 20% de protección) estos datos se compararon con los que no habían sido vacunados. Todas las vacunas aplicadas mostraron un efecto protector con un RM<0.8, con intervalos de confianza variables. Conclusiones: El antecedente de vacunación reduce los riesgos de ser intubado y morir, aun en pacientes previamente vacunados y hospitalizados con Covid-19 grave.


Abstract: Objective: To evaluate the effectiveness of SARS-CoV-2 vaccines to avoid death and intubation in hospitalized patients with Covid-19. Materials and methods: We present an analysis of 3 565 hospitalizations for SARS-CoV-2 in people over 20 years of age, reported for public health purposes by 10 specialty hospitals, comparing those discharged for improvement (2 094) with those who died (1 471) in mixed models of logistic regression adjusted for age, sex, number of comorbidities and the reporting hospital as a random variable. Results: A complete vaccination schedule, with five types of vaccine available, had a protective effect for death or intubation (OR: 0.67, CI95%: 0.54,0.83, 33% protection) and for death (OR: 0.80, CI95%: 0.64,0.99, 20% protection) compared to those who had not been vaccinated. All the applied vaccines in the Mexican program showed a protective effect with an OR<0.8, with variable confidence intervals. Conclusions: Even in patients previously vaccinated and hospitalized with severe Covid-19, a history of vaccination reduces the risks of being intubated and dying.

7.
JPEN J Parenter Enteral Nutr ; 46(4): 828-835, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-34291834

RESUMEN

BACKGROUND: Malnutrition status, body composition indicators, and bioelectrical impedance analysis (BIA) parameters have been associated with increased risk of death in several pathologies. The aim of this study was to describe the associations between phase angle (PhA) indicators obtained by BIA with length of hospital stay, days on mechanical ventilation, and 60-day mortality in critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This is a prospective cohort of mechanically ventilated patients with coronavirus disease 2019 (COVID-19). We assessed nutrition risk and body composition with BIA within 48 h from intensive care unit admission. Logistic and linear regression models were used to analyze the association between variables and clinical outcomes. Survival analysis by PhA value was performed using Kaplan-Meier curves. RESULTS: Sixty-seven patients were included. PhA (odds ratio [OR], 0.36; P = .002), standardized PhA (SPA) (OR, 0.45; P = .001), and extracellular water/total body water ratio (OR, 3.25; P = .002) were significant predictors of 60-day mortality. PhA <3.85° in females and <5.25° in males showed good and fair discrimination, respectively, for mortality prediction. Using cutoff values, low PhA was associated with a significantly increased risk of 60-day mortality (hazard ratio, 3.08; 95% CI, 1.12-8.41; P = .02). No association was detected for SPA. CONCLUSION: Low PhA values could be a predictor of 60-day mortality in critically ill patients with COVID-19. This biological marker could be incorporated as part of nutrition and mortality risk assessment in this population.


Asunto(s)
COVID-19 , Enfermedad Crítica , Enfermedad Crítica/terapia , Impedancia Eléctrica , Femenino , Humanos , Masculino , Estudios Prospectivos , SARS-CoV-2
8.
Nutr Clin Pract ; 37(1): 110-116, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34617311

RESUMEN

BACKGROUND: Few studies have evaluated the prevalence of post-extubation dysphagia and associated factors in patients with coronavirus disease 2019 (COVID-19) . Our study assessed the prevalence of post-extubation dysphagia and body composition in patients with COVID-19 discharged from an intensive care unit (ICU). METHODS: A prospective cohort study was performed in post-ICU extubated patients with acute respiratory distress syndrome related to COVID-19 in two referral hospitals. A total of 112 patients were evaluated and included; swallowing assessment and bioelectrical impedance analysis (BIA) were performed after extubation and discharge from the ICU. To identify associations between dysphagia, lower phase angle (PhA) (<4.8°) and hydration (extracellular water/total body water < 0.390) logistic and linear regression analyses were conducted. RESULTS: The incidence of post-extubation dysphagia was 41% (n = 46). From these, 65% (n = 30) had severe swallowing impairment. Overhydration and PhA were significantly different in patients with dysphagia, and segmental hydration in the trunk and legs was higher than in arms. PhA <4.8° (odds ratio [OR], 12.2; 95% CI, 4.3-34.1; P < .05) and overhydration measured by BIA (OR, 9.1; 95% CI, 3.4-24.5; P < .05) were associated with post-extubation dysphagia in multivariate analysis. PhA (<4.8°) was associated with a lower rate of swallowing recovery at hospital discharge (log-rank test = 0.007). CONCLUSIONS: A high incidence of post-extubation dysphagia was found in patients with COVID-19. Low PhA and overhydration were associated with the presence of dysphagia. Lower PhA was an independent factor for swallowing recovery at discharge.


Asunto(s)
COVID-19 , Trastornos de Deglución , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Humanos , Unidades de Cuidados Intensivos , Alta del Paciente , Estudios Prospectivos , SARS-CoV-2
9.
Front Med (Lausanne) ; 8: 699607, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34513872

RESUMEN

Little literature exists about critically ill patients with coronavirus disease 2019 (COVID-19) from Latin America. Here, we aimed to describe the clinical characteristics and mortality risk factors in mechanically ventilated COVID-19 patients from Mexico. For this purpose, we recruited 67 consecutive mechanically ventilated COVID-19 patients which were grouped according to their clinical outcome (survival vs. death). Clinical risk factors for mortality were identified by machine-learning and logistic regression models. The median age of participants was 42 years and 65% were men. The most common comorbidity observed was obesity (49.2%). Fever was the most frequent symptom of illness (88%), followed by dyspnea (84%). Multilobe ground-glass opacities were observed in 76% of patients by thoracic computed tomography (CT) scan. Fifty-two percent of study participants were ventilated in prone position, and 59% required cardiovascular support with norepinephrine. Furthermore, 49% of participants were coinfected with a second pathogen. Two-thirds of COVID-19 patients developed acute kidney injury (AKIN). The mortality of our cohort was 44.7%. AKIN, uric acid, lactate dehydrogenase (LDH), and a longitudinal increase in the ventilatory ratio were associated with mortality. Baseline PaO2/FiO2 values and a longitudinal recovery of lymphocytes were protective factors against mortality. Our study provides reference data about the clinical phenotype and risk factors for mortality in mechanically ventilated Mexican patients with COVID-19.

10.
PLoS One ; 16(9): e0257238, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34582477

RESUMEN

INTRODUCTION: The novel coronavirus pandemic (COVID-19) represents a major public health problem and it is key to find a treatment that reduces mortality. Our objective was to estimate whether treatment with 400 mg/day of Hydroxychloroquine for 10 days reduces in-hospital mortality in subjects with severe respiratory disease due to COVID-19 compared with placebo. MATERIAL AND METHODS: A double-blind, randomized, placebo-controlled trial to evaluate the safety and efficacy of Hydroxychloroquine for the treatment of severe disease by COVID-19 through an intention-to-treat analysis. Eligible for the study were adults aged more than 18 years with COVID-19 confirmed by RT-PCR and lung injury requiring hospitalization with or without mechanical ventilation. Primary outcome was 30-day mortality. Secondary outcomes: days of mechanical ventilation, days of hospitalization and cumulative incidence of serious adverse events. RESULTS: A total of 214 patients with COVID-19 were recruited, randomized and analyzed. They were hypoxemic with a mean SpO2 of 65% ± 20, tachycardic (pulse rate 108±17 min-1) and tachypneic (32 ±10 min-1); 162 were under mechanical ventilation at randomization. Thirty-day mortality was similar in both groups (38% in Hydroxychloroquine vs. 41% in placebo, hazard ratio [HR] 0.88, 95% Confidence Interval [95%CI] 0.51-1.53). In the surviving participants, no significant difference was found in secondary outcomes. CONCLUSION: No beneficial effect or significant harm could be demonstrated in our randomized controlled trial including 214 patients, using relatively low doses of Hydroxychloroquine compared with placebo in hospitalized patients with severe COVID-19.


Asunto(s)
Tratamiento Farmacológico de COVID-19 , Hidroxicloroquina/uso terapéutico , SARS-CoV-2/metabolismo , Adulto , Antivirales/uso terapéutico , COVID-19/metabolismo , COVID-19/mortalidad , Enfermedades Transmisibles/epidemiología , Método Doble Ciego , Femenino , Hospitalización , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Respiración Artificial , Infecciones del Sistema Respiratorio/epidemiología , SARS-CoV-2/patogenicidad , Resultado del Tratamiento
12.
Front Immunol ; 12: 593595, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33995342

RESUMEN

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is a global health threat with the potential to cause severe disease manifestations in the lungs. Although COVID-19 has been extensively characterized clinically, the factors distinguishing SARS-CoV-2 from other respiratory viruses are unknown. Here, we compared the clinical, histopathological, and immunological characteristics of patients with COVID-19 and pandemic influenza A(H1N1). We observed a higher frequency of respiratory symptoms, increased tissue injury markers, and a histological pattern of alveolar pneumonia in pandemic influenza A(H1N1) patients. Conversely, dry cough, gastrointestinal symptoms and interstitial lung pathology were observed in COVID-19 cases. Pandemic influenza A(H1N1) was characterized by higher levels of IL-1RA, TNF-α, CCL3, G-CSF, APRIL, sTNF-R1, sTNF-R2, sCD30, and sCD163. Meanwhile, COVID-19 displayed an immune profile distinguished by increased Th1 (IL-12, IFN-γ) and Th2 (IL-4, IL-5, IL-10, IL-13) cytokine levels, along with IL-1ß, IL-6, CCL11, VEGF, TWEAK, TSLP, MMP-1, and MMP-3. Our data suggest that SARS-CoV-2 induces a dysbalanced polyfunctional inflammatory response that is different from the immune response against pandemic influenza A(H1N1). Furthermore, we demonstrated the diagnostic potential of some clinical and immune factors to differentiate both diseases. These findings might be relevant for the ongoing and future influenza seasons in the Northern Hemisphere, which are historically unique due to their convergence with the COVID-19 pandemic.


Asunto(s)
COVID-19 , Citocinas , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana , Metaloproteinasa 1 de la Matriz , Metaloproteinasa 3 de la Matriz , Receptores Inmunológicos , Adulto , Anciano , COVID-19/sangre , COVID-19/epidemiología , COVID-19/inmunología , Citocinas/sangre , Citocinas/inmunología , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H1N1 del Virus de la Influenza A/metabolismo , Gripe Humana/sangre , Gripe Humana/epidemiología , Gripe Humana/inmunología , Masculino , Metaloproteinasa 1 de la Matriz/sangre , Metaloproteinasa 1 de la Matriz/inmunología , Metaloproteinasa 3 de la Matriz/sangre , Metaloproteinasa 3 de la Matriz/inmunología , Persona de Mediana Edad , Estudios Prospectivos , Receptores Inmunológicos/sangre , Receptores Inmunológicos/inmunología , Células TH1/inmunología , Células Th2/inmunología
13.
Front Immunol ; 12: 633297, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33717172

RESUMEN

The C-X-C motif chemokine ligand 17 (CXCL17) is chemotactic for myeloid cells, exhibits bactericidal activity, and exerts anti-viral functions. This chemokine is constitutively expressed in the respiratory tract, suggesting a role in lung defenses. However, little is known about the participation of CXCL17 against relevant respiratory pathogens in humans. Here, we evaluated the serum levels and lung tissue expression pattern of CXCL17 in a cohort of patients with severe pandemic influenza A(H1N1) from Mexico City. Peripheral blood samples obtained on admission and seven days after hospitalization were processed for determinations of serum CXCL17 levels by enzyme-linked immunosorbent assay (ELISA). The expression of CXCL17 was assessed by immunohistochemistry (IHQ) in lung autopsy specimens from patients that succumbed to the disease. Serum CXCL17 levels were also analyzed in two additional comparative cohorts of coronavirus disease 2019 (COVID-19) and pulmonary tuberculosis (TB) patients. Additionally, the expression of CXCL17 was tested in lung autopsy specimens from COVID-19 patients. A total of 122 patients were enrolled in the study, from which 68 had pandemic influenza A(H1N1), 24 had COVID-19, and 30 with PTB. CXCL17 was detected in post-mortem lung specimens from patients that died of pandemic influenza A(H1N1) and COVID-19. Interestingly, serum levels of CXCL17 were increased only in patients with pandemic influenza A(H1N1), but not COVID-19 and PTB. CXCL17 not only differentiated pandemic influenza A(H1N1) from other respiratory infections but showed prognostic value for influenza-associated mortality and renal failure in machine-learning algorithms and regression analyses. Using cell culture assays, we also identified that human alveolar A549 cells and peripheral blood monocyte-derived macrophages increase their CXCL17 production capacity after influenza A(H1N1) pdm09 virus infection. Our results for the first time demonstrate an induction of CXCL17 specifically during pandemic influenza A(H1N1), but not COVID-19 and PTB in humans. These findings could be of great utility to differentiate influenza and COVID-19 and to predict poor prognosis specially at settings of high incidence of pandemic A(H1N1). Future studies on the role of CXCL17 not only in severe pandemic influenza, but also in seasonal influenza, COVID-19, and PTB are required to validate our results.


Asunto(s)
Biomarcadores/metabolismo , Quimiocinas CXC/metabolismo , Subtipo H1N1 del Virus de la Influenza A/fisiología , Gripe Humana/diagnóstico , Pulmón/metabolismo , Mycobacterium tuberculosis/fisiología , SARS-CoV-2/fisiología , Adulto , Anciano , COVID-19/diagnóstico , COVID-19/mortalidad , Quimiocinas CXC/genética , Quimiocinas CXC/inmunología , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Humanos , Gripe Humana/mortalidad , Pulmón/patología , Masculino , México , Persona de Mediana Edad , Pandemias , Evaluación del Resultado de la Atención al Paciente , Pronóstico , Análisis de Supervivencia , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/mortalidad , Adulto Joven
14.
J Infect Dis ; 224(1): 21-30, 2021 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-33668070

RESUMEN

The differentiation between influenza and coronavirus disease 2019 (COVID-19) could constitute a diagnostic challenge during the ongoing winter owing to their clinical similitude. Thus, novel biomarkers are required to enable making this distinction. Here, we evaluated whether the surfactant protein D (SP-D), a collectin produced at the alveolar epithelium with known immune properties, was useful to differentiate pandemic influenza A(H1N1) from COVID-19 in critically ill patients. Our results revealed high serum SP-D levels in patients with severe pandemic influenza but not those with COVID-19. This finding was validated in a separate cohort of mechanically ventilated patients with COVID-19 who also showed low plasma SP-D levels. However, plasma SP-D levels did not distinguish seasonal influenza from COVID-19 in mild-to-moderate disease. Finally, we found that high serum SP-D levels were associated with death and renal failure among severe pandemic influenza cases. Thus, our studies have identified SP-D as a unique biomarker expressed during severe pandemic influenza but not COVID-19.


Asunto(s)
COVID-19/genética , Expresión Génica , Interacciones Huésped-Patógeno/genética , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/genética , Proteína D Asociada a Surfactante Pulmonar/genética , SARS-CoV-2 , Adulto , Anciano , Biomarcadores , COVID-19/sangre , COVID-19/diagnóstico , COVID-19/virología , Coinfección , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Gripe Humana/diagnóstico , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Pronóstico , Proteína D Asociada a Surfactante Pulmonar/sangre , Índice de Severidad de la Enfermedad , Evaluación de Síntomas , Adulto Joven
15.
Rev Invest Clin ; 71(5): 311-320, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31599877

RESUMEN

BACKGROUND: Severe hypoxemic respiratory failure (SHRF) due to Pneumocystis jiroveci pneumonia (PJP) in AIDS patients represents the main cause of admission and mortality in respiratory intensive care units (RICUs) in low- and middle-income countries. OBJECTIVE: The objective of this study was to develop a predictive scoring system to estimate the risk of mortality in HIV/AIDS patients with PJP and SHRF. METHODS: We analyzed data of patients admitted to the RICU between January 2013 and January 2018 with a diagnosis of HIV infection and PJP. Multivariate logistic regression and Kaplan-Meier method were used in data analysis. The RICU and inhospital mortality were 25% and 26%, respectively. Multivariate analysis identified four independent predictors: body mass index, albumin, time to ICU admission, and days of vasopressor support. A predictive scoring system was derived and validated internally. The discrimination was 0.869 (95% confidence interval: 0.821-0.917) and calibration intercept (α) and slope (ß) were 0.03 and 0.99, respectively. The sensitivity was 47.2%, specificity was 84.6%, positive predictive value was 89.2%, and negative predictive value was 82.6%. CONCLUSIONS: This scoring system is a potentially useful tool to assist clinicians, in low- and medium-income countries, in estimating the RICU and inhospital mortality risk in patients with HIV/AIDS and SHRF caused by PJP.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/mortalidad , Infecciones por VIH/mortalidad , Neumonía por Pneumocystis/mortalidad , Insuficiencia Respiratoria/mortalidad , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Mortalidad Hospitalaria , Humanos , Hipoxia/etiología , Hipoxia/mortalidad , Unidades de Cuidados Intensivos , Masculino , Neumonía por Pneumocystis/etiología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Insuficiencia Respiratoria/etiología , Sensibilidad y Especificidad
16.
Rev. invest. clín ; Rev. invest. clín;71(5): 311-320, Sep.-Oct. 2019. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1289701

RESUMEN

Background Severe hypoxemic respiratory failure (SHRF) due to Pneumocystis jiroveci pneumonia (PJP) in AIDS patients represents the main cause of admission and mortality in respiratory intensive care units (RICUs) in low- and middle-income countries. Objective The objective of this study was to develop a predictive scoring system to estimate the risk of mortality in HIV/AIDS patients with PJP and SHRF. Methods We analyzed data of patients admitted to the RICU between January 2013 and January 2018 with a diagnosis of HIV infection and PJP. Multivariate logistic regression and Kaplan–Meier method were used in data analysis. The RICU and inhospital mortality were 25% and 26%, respectively. Multivariate analysis identified four independent predictors: body mass index, albumin, time to ICU admission, and days of vasopressor support. A predictive scoring system was derived and validated internally. The discrimination was 0.869 (95% confidence interval: 0.821-0.917) and calibration intercept (α) and slope (β) were 0.03 and 0.99, respectively. The sensitivity was 47.2%, specificity was 84.6%, positive predictive value was 89.2%, and negative predictive value was 82.6%. Conclusions This scoring system is a potentially useful tool to assist clinicians, in low- and medium-income countries, in estimating the RICU and inhospital mortality risk in patients with HIV/AIDS and SHRF caused by PJP.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Neumonía por Pneumocystis/mortalidad , Insuficiencia Respiratoria/mortalidad , Infecciones por VIH/mortalidad , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Neumonía por Pneumocystis/etiología , Pronóstico , Insuficiencia Respiratoria/etiología , Infecciones por VIH/complicaciones , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estudios de Cohortes , Sensibilidad y Especificidad , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , Hipoxia/etiología , Hipoxia/mortalidad
17.
Int J Infect Dis ; 89: 87-95, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31493523

RESUMEN

OBJECTIVES: To evaluate the performance of rapid influenza diagnostic tests (RIDT) and influenza vaccines' effectiveness (VE) during an outbreak setting. METHODS: We compared the performance of a RIDT with RT-PCR for influenza virus detection in influenza-like illness (ILI) patients enrolled during the 2016/17 season in Mexico City. Using the test-negative design, we estimated influenza VE in all participants and stratified by age, virus subtype, and vaccine type (trivalent vs quadrivalent inactivated vaccines). The protective value of some clinical variables was evaluated by regression analyses. RESULTS: We enrolled 592 patients. RT-PCR detected 93 cases of influenza A(H1N1)pdm09, 55 of AH3N2, 141 of B, and 13 A/B virus infections. RIDT showed 90.7% sensitivity and 95.7% specificity for influenza A virus detection, and 91.5% sensitivity and 95.3% specificity for influenza B virus detection. Overall VE was 33.2% (95% CI: 3.0-54.0; p = 0.02) against any laboratory-confirmed influenza infection. VE estimates against influenza B were higher for the quadrivalent vaccine. Immunization and occupational exposure were protective factors against influenza. CONCLUSIONS: The RIDT was useful to detect influenza cases during an outbreak setting. Effectiveness of 2016/17 influenza vaccines administered in Mexico was low but significant. Our data should be considered for future local epidemiological policies.


Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Gripe Humana/diagnóstico , Adolescente , Adulto , Niño , Pruebas Diagnósticas de Rutina/métodos , Brotes de Enfermedades , Femenino , Humanos , Inmunización , Subtipo H1N1 del Virus de la Influenza A/genética , Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/genética , Virus de la Influenza B/inmunología , Virus de la Influenza B/aislamiento & purificación , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Gripe Humana/inmunología , Gripe Humana/prevención & control , Masculino , México/epidemiología , Persona de Mediana Edad , Estaciones del Año , Vacunación , Adulto Joven
18.
Rev Invest Clin ; 68(5): 235-244, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27941959

RESUMEN

BACKGROUND: Acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09 virus is the leading cause of death among this patient population. Expanding the knowledge of its course and predictors of mortality is relevant to decision making. We aimed to describe the clinical characteristics and identify factors associated with mortality in patients with acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09 during the 2013-2014 influenza season. METHODS: This is an observational study of a prospective cohort of 70 patients with acute respiratory distress syndrome and influenza A(H1N1) pdm09 seen in an academic medical center. Multivariate logistic regression was used to identify the independent mortality predictors. Bootstrap was used for internal model validation. RESULTS: This cohort was represented by young adults (43 ± 11 years old). Obesity was present in 62.5% and was not associated with mortality. Mortality at 28 days and at discharge from the respiratory intensive care unit was 14 and 20%, respectively. All patients met the criteria for acute respiratory distress syndrome, 73% had vasodilatory shock, and 27.1% had acute kidney injury on respiratory intensive care unit admission. We observed a high incidence of intensive care unit-acquired weakness (81.4%). Ventilator-associated pneumonia developed in 47.1% and was not associated with mortality. In multivariate analysis, independent risk factors for intensive care unit mortality were age (odds ratio [OR] = 1.102), white blood cell count (OR = 1.22), and lactate dehydrogenase levels (OR = 1.004) on admission to the intensive care unit. CONCLUSIONS: We described the clinical characteristics and course of a cohort of patients with acute respiratory distress syndrome secondary to influenza A(H1N1)pdm09, and developed a predictive model of mortality based on the covariates age, levels of lactate dehydrogenase, and white cell count on admission to the respiratory intensive care unit.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/complicaciones , Modelos Estadísticos , Síndrome de Dificultad Respiratoria/etiología , Centros Médicos Académicos , Adulto , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Gripe Humana/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Obesidad/epidemiología , Neumonía Asociada al Ventilador/epidemiología , Estudios Prospectivos , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/virología , Factores de Riesgo
19.
Rev Invest Clin ; 68(4): 169-70, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27623033

RESUMEN

In the well-known Berlin definition of acute respiratory distress syndrome (ARDS), there is a recommended adjustment for arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FIO2) at altitude, but without a reference as to how it was derived.


Asunto(s)
Altitud , Oxígeno/sangre , Síndrome de Dificultad Respiratoria/fisiopatología , Simulación por Computador , Humanos , Presión Parcial , Síndrome de Dificultad Respiratoria/clasificación , Índice de Severidad de la Enfermedad
20.
Crit Care Med ; 44(10): 1861-70, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27359085

RESUMEN

OBJECTIVES: The 2009-2010 influenza A (H1N1pdm09) pandemic caused substantial morbidity and mortality among young patients; however, mortality estimates have been confounded by regional differences in eligibility criteria and inclusion of selected populations. In 2013-2014, H1N1pdm09 became North America's dominant seasonal influenza strain. Our objective was to compare the baseline characteristics, resources, and treatments with outcomes among critically ill patients with influenza A (H1N1pdm09) in Mexican and Canadian hospitals in 2014 using consistent eligibility criteria. DESIGN: Observational study and a survey of available healthcare setting resources. SETTING: Twenty-one hospitals, 13 in Mexico and eight in Canada. PATIENTS: Critically ill patients with confirmed H1N1pdm09 during 2013-2014 influenza season. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were 90-day mortality and independent predictors of mortality. Among 165 adult patients with H1N1pdm09-related critical illness between September 2013 and March 2014, mean age was 48.3 years, 64% were males, and nearly all influenza was community acquired. Patients were severely hypoxic (median PaO2-to-FIO2 ratio, 83 mm Hg), 97% received mechanical ventilation, with mean positive end-expiratory pressure of 14 cm H2O at the onset of critical illness and 26.7% received rescue oxygenation therapy with prone ventilation, extracorporeal life support, high-frequency oscillatory ventilation, or inhaled nitric oxide. At 90 days, mortality was 34.6% (13.9% in Canada vs 50.5% in Mexico, p < 0.0001). Independent predictors of mortality included lower presenting PaO2-to-FIO2 ratio (odds ratio, 0.89 per 10-point increase [95% CI, 0.80-0.99]), age (odds ratio, 1.49 per 10 yr increment [95% CI, 1.10-2.02]), and requiring critical care in Mexico (odds ratio, 7.76 [95% CI, 2.02-27.35]). ICUs in Canada generally had more beds, ventilators, healthcare personnel, and rescue oxygenation therapies. CONCLUSIONS: Influenza A (H1N1pdm09)-related critical illness still predominantly affects relatively young to middle-aged patients and is associated with severe hypoxemic respiratory failure. The local critical care system and available resources may be influential determinants of patient outcome.


Asunto(s)
Enfermedad Crítica/terapia , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/fisiopatología , Gripe Humana/terapia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Corticoesteroides/economía , Corticoesteroides/uso terapéutico , Adulto , Anciano , Antivirales/economía , Antivirales/uso terapéutico , Canadá/epidemiología , Enfermedad Crítica/epidemiología , Oxigenación por Membrana Extracorpórea/economía , Oxigenación por Membrana Extracorpórea/métodos , Femenino , Gastos en Salud , Humanos , Gripe Humana/economía , Gripe Humana/epidemiología , Masculino , México/epidemiología , Persona de Mediana Edad , Respiración Artificial/economía , Respiración Artificial/métodos , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia
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